无创正压通气治疗慢性阻塞性肺疾病急性发作伴神志障碍的疗效和安全性

Efficacy and safety of noninvasive positive pressure ventilation(NPPV) in the patients with conscious disturbance due to acute exacerbation of chronic obstructive pulmonary disease

目的评价应用经口鼻面罩无创正压通气(NPPV)救治慢性阻塞性肺疾病(COPD)并重度呼吸衰竭伴神志障碍的疗效和安全性。方法前瞻性分析评价NPPV对COPD重度呼吸衰竭伴有神志障碍,且格拉斯哥昏迷评分(GCS)<10分的患者为研究组。格拉斯哥昏迷评分(GCS)>10分且没有神志障碍者为对照组。两组均接受NPPV,观察通气前、通气后2、24和72 h的呼吸频率、GCS评分和血气分析。结果神志障碍71例患者中51例经NPPV后经面罩通气后好转出院,20例患者需气管插管。无神志障碍54例患者中76%NPPV成功。结论NPPV不是对COPD重度呼吸衰竭伴有神志障碍患者的禁忌证。

Objective To evaluate the efficacy and safety of noninvasive positive pressure ventilation （NPPV） in the patients with conscious disturbance due to acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and respiratory failure. Methods A prospective case control study was conducted in respiratory department. The study was to determine the success of NPPV therapy in patients with conscious disturbance due to AECOPD（ defined as a response to therapy allowing the patient to avoid endotracheal intubation）. Conscious disturbance AECOPD patients requMng NPPV were assigned into one group （ GCS 〈 10 ）. The undisturbed conscious AECOPD patients requiring NPPV were assigned into the another group （GCS 〉 10）. Results Fifty -one of 71 conscious disturbance AECOPD responded to NPPV therapy, The pH,GCS,PaCO2 and PaO2/FiO2 improved significantly before and after ventilation at 2 hours, 24 hours and 72 hours respectively. There was no significant difference between two groups. Conclusion Patients with conscious disturbance secondary to AECOPD can be treated as successfully with NPPV as awake patients with AECOPD, the conscious disturbance may be not a contraindication of NPPV.